ArticleMedical decision making : an international journal of the Society for Medical Decision Making2023
A Tutorial on Time-Dependent Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Developing a Comprehensive Framework for Cost-Effectiveness Evaluation in Metastatic Castration-Sensitive Prostate Cancer: Insights from a Systematic Review.PharmacoEconomics · 2025Pooled it
- Cost-effectiveness of multimodal intervention for the prevention of dementia in Japan.The journal of prevention of Alzheimer's disease · 2026Trial
- A Cardiovascular Care Pathway Supported by Remote Patient Management in Dutch Primary Care: Cost-Effectiveness, Budget Impact, and Workload Analysis.JMIR mHealth and uHealth · 2026Article
- A Tutorial on Discrete Event Simulation Models Using a Cost-Effectiveness Analysis Example in R.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- Exploring the cost-effectiveness of 3-D-guided versus traditional 2-D corrective osteotomy in patients with a distal radius malunion.Cost effectiveness and resource allocation : C/E · 2026Article
- Cost-Effectiveness Analysis of Bariatric Surgery and Pharmacological Treatments for People with Obesity and Type 2 Diabetes Mellitus.Obesity surgery · 2026Article
- Article
- Modeling the cost-effectiveness of introducing donation after controlled circulatory death for heart transplantation in France.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Integrating clinical and economic outcomes in the elderly myeloma management: a comparative cost-effectiveness analysis.Frontiers in oncology · 2026Article
- Cost-Effectiveness Modelling of Multiple System Atrophy for Early Health Technology Assessment.PharmacoEconomics - open · 2026Article
- Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery.American heart journal plus : cardiology research and practice · 2025Article
- Cost-effectiveness of a clinical decision support system for atrial fibrillation: an RCT-based modelling study.European heart journal. Digital health · 2025Article
- A Cost-Effectiveness Analysis of Rivaroxaban Compared to Warfarin for the Management of Venous Thromboembolism in Western Kenya.Clinical drug investigation · 2025Article
- Cost and Cost-Effectiveness of Treating Human Epidermal Growth Factor Receptor 2-Low Metastatic Breast Cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025Article
- Article
- Making Drug Approval Decisions in the Face of Uncertainty: Cumulative Evidence versus Value of Information.Medical decision making : an international journal of the Society for Medical Decision Making · 2024Article
- Evaluating the Validation Process: Embracing Complexity and Transparency in Health Economic Modelling.PharmacoEconomics · 2024Article
- Cost-effectiveness of endovascular treatment after 6-24 h in ischaemic stroke patients with collateral flow on CT-angiography: A model-based economic evaluation of the MR CLEAN-LATE trial.European stroke journal · 2024Article
- A Simple Cost-Effectiveness Model of Screening: An Open-Source Teaching and Research Tool Coded in R.PharmacoEconomics - open · 2023Article
- An Introductory Tutorial on Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example.Medical decision making : an international journal of the Society for Medical Decision Making · 2023Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
In an introductory tutorial, we illustrated building cohort state-transition models (cSTMs) in R, where the state transition probabilities were constant over time. However, in practice, many cSTMs require transitions, rewards, or both to vary over time (time dependent). This tutorial illustrates adding 2 types of time dependence using a previously published cost-effectiveness analysis of multiple strategies as an example. The first is simulation-time dependence, which allows for the transition probabilities to vary as a function of time as measured since the start of the simulation (e.g., varying probability of death as the cohort ages). The second is state-residence time dependence, allowing for history by tracking the time spent in any particular health state using tunnel states. We use these time-dependent cSTMs to conduct cost-effectiveness and probabilistic sensitivity analyses. We also obtain various epidemiological outcomes of interest from the outputs generated from the cSTM, such as survival probability and disease prevalence, often used for model calibration and validation. We present the mathematical notation first, followed by the R code to execute the calculations. The full R code is provided in a public code repository for broader implementation.
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